Vascular access for hemodialysis: current perspectives

Figures & data

Figure 1 Native radio-cephalic arteriovenous fistula for hemodialysis, with latero-terminal anastomosis.

Table 1 Graft materials

Type	Material	Characteristic
Biological	Denatured homologous vein allograft
	Cryopreserved saphenous vein	Caution should be exercised in patients at high risk for infection.
	Bovine heterografts – typified by SGVG 100	Safe alternative for patients with a history of multiple failed synthetic grafts.^Citation25
	Human umbilical vein
	Sheep collagen grafts
Synthetic	Dacron^® (E.I. du Pont de Nemours and Company, Wilmington, DE, USA)
	PTFE	This fluorocarbon polymer has become the prosthetic graft of choice. Stretch ePTFE is preferable to standard ePTFE.
	Procol^® (Hancock, Jaffe, Laboratories, Irvine, CA, USA) bovine mesenteric vein graft, which closely resembles the human saphenous vein	Higher graft survival for the bioprosthesis versus ePTFE (82% versus 50%; P<0.04) over a period of 20 months.

Abbreviations: ePTFE, expanded PTFE; PTFE, polytetrafluoroethylene; SGVG 100, SynerGraft Vascular Graft Model 100.

Figure 2 Synthetic axillo–axillary graft in polytetrafluoroethylene material.

Table 2 Central vein approaches for dialysis catheters

Priority	Vein	Advantages	Disadvantages or complications
First choice	Internal jugular vein	Best with ultrasound	Medium infection risk
		Right side gives more chance to correct blind catheter tip placement	Medium bleeding risk
			Uncomfortable when not tunneled
Second choice	Femoral vein	Lower bleeding risk	Higher infection risk
		No need for radiological control after insertion	Higher thrombosis risk
			Poor catheter performance when patient sits up
Third choice (avoid proximal or terminal arteriovenous fistula in the same side)	Subclavian vein	Lower infection risk	Higher bleeding risk
		Suitability for subcutaneous tunneling and port access	Higher pneumothorax risk
			Higher thrombosis risk
			“Blind” procedure that cannot be guided with ultrasound

Figure 3 Photograph of neck in a malnourished patient demonstrating surface anatomy.

Note: It shows Sedillot’s triangle, formed by the sternal (SH) and clavicular (CH) heads of the sternocleidomastoid. Inside this triangle is the approximate normal course of the internal jugular vein.

Figure 4 Percentage of variation in anatomical relations between the right and left internal jugular vein (in blue) and common carotid artery (C).

Figure 5 Ultrasound cross-sectional (left) and Doppler ultrasound (right) image of right internal jugular vein (IJV) and carotid artery (CA).

Note: Both vessels are very superficial since they are in a range of depth of field between 1 and 2.5 cm.

Figure 6 External abdomen location of cuffed tunneled central venous catheters in femoral vein, as a variant of the normal external leg location.

MurphyGJWhiteSANicholsonMLVascular access for haemodialysisBr J Surg200087101300131511044154

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